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Thursday, July 14, 2011

Late Talkers: What To Do

boy and parents

In the last post , we talked about young children whose speech skills are lagging, and when further evaluation and therapy are more essential. Now it’s time to cover what parents of late talkers ought to do to help their children catch up.

First, a medical evaluation is essential. Your child probably had a newborn hearing screen, but repeating that is very important. Any degree of hearing deficit may contribute to difficulties acquiring word skills, and not all hearing problems are apparent at birth. For instance, children with frequent or prolonged ear infections may frequently hear words muffled, making it difficult for them to learn to articulate sounds well. Your pediatrician may need to refer for a thorough hearing evaluation. In addition, a general medical evaluation will include an overall assessment of oral skills and development that may require further intervention.

Parents should look into government-sponsored programs that provide speech and other therapy services to children with developmental delays. In many states, these programs are called “Early Intervention,” and can help coordinate both evaluation and treatment your local pediatrician will know how to refer into the most appropriate local program.

Parents at home should gently encourage word skills. Turn off the television, and talk with your child. Provide a daily, nearly-constant running commentary about what’s going on. Never tease your child or insist that she uses words to get what she wants, but help her by saying the words she should be using. Don’t speak in an extremely exaggerated way, but do make your words a little clearer and speak a little slower.

Be mindful that toddlers with delayed word skills may be more-easily frustrated, and more prone to tantrums. It makes sense — Junior knows what he wants, but can’t explain it clearly to you. Parents may need a few extra lessons from a pediatrician or someone else very familiar with toddler behavior on the best way to handle these issues. Recent research has shown that late talkers do indeed have somewhat more problem behaviors at age two — but these issues disappear as they get older. Still, it can be a rough few years as children catch up.

Formal speech therapy is the best way to help a language-delayed child. Your family should work with a therapist with pediatric training and experience (adult speech issues are very different from those of children.) In pediatric speech therapy, a lot of the “work” will take place at home, between formal sessions. It’s crucial for parents to continue this “homework” to make good progress.

Some children who are speech delayed may need further services, such as occupational therapy. This can especially help kids with poor muscle tone, or sensory issues that distract from speech. Your therapist and pediatrician can help guide you about these decisions. For children with very severe delays, multiple developmental challenges, or complex medical problems that affect development, working with a developmental specialist pediatrician, geneticist, or neurologist may also be helpful. Again, work with your child’s primary doctor for guidance.

As your child continues in therapy, as yourself from month-to-month, “Is my child making progress?” If you’re not seeing improvements, you may need to switch therapy styles and therapists, and re-assess what’s going on to look for complicating factors.

Speaking is a skill, not that different from using a spoon or riding a bike. Some kids will take to learning to talk faster than others, so it’s important to appreciate that there is a “broad range” of normal. Children who are genuinely delayed, not making progress, or having multiple developmental lags need further evaluation and therapy, and the most-effective approaches are best started early, when the problem has become apparent. Parents need to stay involved both by continuing therapy skills practice at home, and by keeping track and making sure that progress is continuing. With good therapy, your child should be able to catch up and do well.

- Roy Benaroch, MD

Photo: Hemera Technologies/© Getty Images

Posted by: Roy Benaroch, MD, FAAP at 9:36 am

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